A drug, by definition, is a medicine or substance that has a physiological effect when ingested or introduced into the body. Medications are utilized daily in the field of dermatology to treat a variety of skin conditions, such as eczema, psoriasis, and warts. The purpose of this column is to highlight common medicines used in dermatology, focusing on their mechanisms of action, usage and function, and available alternatives. This article describes the features of podophyllotoxin, utilized in diluted solution as podofilox, a topical treatment for external genital warts, such as condylomata acuminata.
A 62-year-old woman presented with a three-month history of fatigue, fevers, bruising, epistaxis, and rash. Physical examination revealed erythematous and violaceous non-blanching papules and macules, coalescing into patches and plaques on the bilateral lower and upper extremities, abdomen, and back (See Image 1 Panel A and B). Physical examination revealed bilateral supraclavicular lymphadenopathy and hepatosplenomegaly. Laboratory studies revealed pancytopenia. Bone marrow biopsy revealed hypercellular marrow with "fried egg" appearance, and immunophenotyping positive for CD11c, CD25, and CD103, diagnostic for hairy cell leukemia. A skin lesion biopsy revealed leukocytoclasis with extravasated erythrocytes on H&E (See Image 1 Panel C), as well as direct immunofluorescence positive staining for perivascular IgA, IgG, IgM, C3, and fibrinogen (See Image 1 Panel D), consistent with leukocytoclastic vasculitis. She was treated with topical triamcinolone and seven -day induction therapy with cladribine. Complete resolution of rash and leukemia occurred rapidly with sustained remission 14 months later. Malignancy is frequently diagnosed concurrent to autoimmune diseases including vasculitis. 1 Vasculitis occurs simultaneously in 5% to 8% of primary lymphoproliferative disorders. 2 This occurrence has been previously hypothesized to be autoimmune in nature due to cross-reactivity between hairy cells and vascular endothelium. 3 Case reports have similarly shown resolution of symptoms after treatment of primary underlying hematologic malignancy. 4,5 Therefore, hematologic malignancies should be considered as a potential underlying etiology for newly diagnosed leukocytoclastic vasculitis.
BACKGROUND
Lateral tarsal strip (LTS) and medial spindle (MS) procedures are surgical techniques used to address cicatricial ectropion.
OBJECTIVE
To evaluate the clinical characteristics and efficacy of simultaneous LTS and MS procedures for repair of cicatricial ectropion occurring after dermatologic surgeries.
METHODS
A retrospective review of all cases of symptomatic, cicatricial, lateral, and medial punctal ectropion in 1 author's (C.C.) practice over 2 years was performed. Those resulting from dermatologic surgical procedures and repaired with simultaneous LTS and MS procedures were included.
RESULTS
Fifty-six tumors involving the lower eyelid were considered highly at risk and treated with Mohs micrographic surgery and reconstruction in the senior author's practice during the review period, resulting in 3 (5.3%) cases of cicatricial ectropion. Five additional cases resulted from Mohs surgery and 7 resulted from excisions of pigmented lesions, all performed by other surgeons. One postoperative complication (6.7%) of undercorrection required reoperation, with initial surgical success rate being 93.3% and overall surgical success being 100% after the single reoperation.
CONCLUSION
Simultaneous LTS and MS are useful procedures for dermatologic surgeons yielding high surgical success and a low complication rate for correction of medial and lateral cicatricial ectropion with punctal eversion.
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